Dear Dr Cummings

Regulation 28 Report - Fatal Road Crash, A5 Little Brickhill, 16 November 2023

Thank you for contacting me regarding the tragic events of 16 November 2023. We have been asked to respond to the Regulation 28 Report (Report to prevent future deaths) on 21 December 2023 with a deadline set of 14 February 2024. This letter sets out our position in respect of:

• Confirmation of any concerns raised with MKCC regarding this junction.
• Copies of the concerns raised.
• MKCC’s responses to these concerns.

MKCC has received no formal complaints in relation this junction nor related signage that we have been able to establish from examination of our customer service records. We have had some reports using our on-line forms and a note of those is set out in the annex to this letter.

The slip road, its junction with the local road, and the signage and road markings at the end of the slip road are part of the National Highways asset and they are therefore the responsible highway authority.

MKCC has no powers to action any improvements to the junction mouth, the signage located there, or any road markings to prevent unauthorised entry. MKCC is highway authority for the local road that the A5 on and off slips connect to.

Comments about the absence of highway lighting in the vicinity are noted, and this would be MKCC’s responsibility on the connecting local road and National Highway’s on the slip road, although it is a rural location and there is no nearby power supply at present.

City highways officials visited the site on 20 November after the fatal incident with Thames Valley Police (TVP). TVP then convened a video call with MKCC and National Highways on 21 November and National Highways took subsequent actions on their junction. We would

Civic, 1 Saxon Gate East, Central Milton Keynes, MK9 3EJ

agree with National Highways that the signage appeared adequate to regulations, although we would suggest that the National Highways no-entry signage at the slip road junction may benefit from illumination (although the Traffic Signs Regulations and General Directions guidance does not require this).

We will, of course, co-operate with any actions arising from the inquest that are in our power.

Dear Mr. Cummings, We are writing in response to your reports dated 22nd and 23rd August 2024, regarding the accident at the A5 near the Little Brickhill junction. First of all, we would like to extend our condolences to all those affected by this tragic event. At TomTom, the safety of our customers and all road users is our priority, and we take security matters very seriously. Following the report, we reviewed our navigation systems’ verbal instructions provided near the junction at hand. We have simulated different scenarios, including speed variations of 60mph and 30mph, to better understand how our navigation systems presented instructions based on driver speed. The scenarios assumed that the driver would either (i) maintain maximum speed until the junction; or (ii) slow down when approaching it. The outcome of the review revealed that instructions were given either (i) right when passing by the off-slip road; or (ii) after passing by the off-slip road, when on the overpass towards the exit. As part of our ongoing efforts to enhance road safety, we recently implemented additional safeguards, to limit drivers’ confusion where possible, regardless of their speed behavior on the road, by timing the verbal commands closer to the actual exit, and in any event after passing the off-slip road. However, please note that in order for these changes to be effective and visible by end users, they need to use the latest map and therefore in certain circumstances need to update their systems/devices. Although our navigation systems offer road assistance and simplify each journey, drivers remain responsible for driving. That said, we believe that the mentioned changes in verbal instructions, combined with the steps taken by National Highways to improve safety at this location will provide drivers with clearer and more timely guidance. Thank you for bringing this to our attention. Please do not hesitate to contact us if you have any further questions. This letter is submitted without prejudice and TomTom reserves all rights accordingly.

Dear Sean Cummings Regulation 28: Report to Prevent Future Deaths – Tracey Haybittle and Amal Ahmed We refer to your report dated 22 August 2024 regarding Mrs Haybittle and to your report dated 23 August 2024 regarding Ms Ahmed. This letter serves as a formal response to the queries and points raised within the reports. Circumstances of death We are deeply saddened to hear of the tragic circumstances relating to the deaths of Mrs Haybittle and Ms Ahmed. We understand from the reports that on 20 November 2023, Ms Ahmed’s vehicle collided with Mrs Haybittle’s vehicle on the A5 adjacent to the Little Brickhill junction. Ms Ahmed died at the scene; Mrs Haybittle died later at the John Radcliffe Hospital. A passenger of one of the vehicles required critical care and suffered life threatening and changing injuries. The reports indicate that Ms Ahmed appeared to have been using a GPS – or “satnav” – navigation system, but mistakenly entered the “off” slip road at the Little Brickhill junction and drove the wrong way at speed before colliding with Mrs Haybittle. We understand that the junction was painted with “No Entry” on the road surface – along with white, double broken lines (indicating “give way”) – and was flanked by two red “No Entry” road signs. National Highways subsequently undertook a number of measures to prevent other drivers from incorrectly entering the slip road, but observed that drivers frequently continued to do so. Enquiries by the police and information volunteered by members of the public suggested that the audio guidance given by their satnav systems may be confusing drivers into making the incorrect manoeuvre. Google Maps Google Maps is a mapping and navigation application provided to users in the UK by Google LLC. It can provide directions for users to travel from one point to another on foot, in a vehicle, by bicycle or by public transport. The application offers directions that can visibly be shown on the user’s device and/or offers audio guidance to prepare users for upcoming manoeuvres, and to guide them to the point at which they must turn or make the manoeuvre. Registered address: Belgrave House, 76 Buckingham Palace Road, London SW1W 9TQ Registered in England and Wales with registration number 03977902

Google UK Limited Belgrave House, 76 Buckingham Palace Road, London SW1W 9TQ, United Kingdom Safety is core to how Google develops and operates the Google Maps service, and we understand our responsibility to keep our users and other road users safe. We implement a multi-layered approach to ensure navigation instructions are provided safely, including through real-time data updates and algorithm optimisation, user feedback and reporting, and integration with other safety features such as Car Crash Detection on certain Pixel devices. We endeavour to ensure that any audio guidance given by Google Maps serves as a useful tool for drivers, though users must always obey road signs and traffic signals. Steps taken in response to the reports We recognise that the cases identified in the reports are tragic. While it is not clear whether Google Maps was involved, we have carefully considered whether there are improvements we can make to Google Maps to help ensure that similar incidents do not occur in future. We have therefore taken the following measures: ● We have liaised with National Highways and reviewed their helpful dashcam footage of the relevant junction. This has assisted our product and engineering teams in carefully investigating the audio guidance provided by Google Maps. Our teams are working on improvements to the timing of the audio guidance. ● As part of these improvements, we anticipate providing enhanced audio guidance in situations such as those in this case. This will involve an amended audio prompt as a driver approaches a junction where they would cross an overpass: “after the overpass, turn right”. We hope that this will provide clearer guidance for drivers and help reduce the risk that they make an incorrect turn. Although changes such as these require significant internal validation before they can be launched publicly, we hope to launch them in the near future. More generally, Google remains committed to continually improving its services to provide helpful navigation services, and we welcome feedback from users which can be submitted through the Google Maps mobile application or website.

Dear ,

Thank you for your email providing Regulation 28 Preventing Future Death Reports which was passed to Apple’s privacy and law enforcement requests team for review.  We immediately investigated the concerns raised and found no data or routing error on Maps which would have contributed to these tragic events. 

However, to ensure we were following the very best approach we are taking an additional measure to add the following special voice guidance for drivers heading past the A5 offramp toward the A5 onramp, which we intend will be live by the start of next week.
- Drivers heading past the A5 offramp toward the A5 onramp would be instructed to "Continue straight at the overpass” (that will happen as they are traveling west toward the offramp).
- While on the overpass, drivers would be instructed to “Turn right onto A5 toward Milton Keynes, Bletchley."

We trust that the steps we are taking will be helpful to try to avoid any future such tragic events.